Critical Care Issues in Marrow Transplantation: Intestinal and Liver Complications

Abstract

Gastrointestinal complications of blood and marrow transplantation are common. Management of critical gastrointestinal complications may be different from that in other critically ill patients. The etiologies of some complications have changed over time; for example, viral and fungal esophagitis is less common in the presence of prophylactic anti-infective treatment. However, liver disease, diarrhea, abdominal pain and bleeding persist as frequent complaints. The etiologies may be multiple, ranging from conditioning therapy graft-vs-host disease (GVHD), infections, and peptic disease to pancreatitis. The role of an experienced surgeon is often an important one, and surgery is occasionally necessary for diagnosis and treatment. Knowledge of the incidence, risk factors, and presentation of gastrointestinal complications is important in recognizing potentially life-threatening events and avoiding unnecessary procedures.